Individual
RAISHELLE LAVETTE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2695 MOCKINGBIRD LN, FLORISSANT, MO 63031-3711
(314) 520-4142
Mailing address
2695 MOCKINGBIRD LN, FLORISSANT, MO 63031-3711
(314) 520-4142
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018027756
MO
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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